Sun Lakes Physical Therapy Inc

Primary specialty

Rehabilitation Clinic/CenterTaxonomy code 261QR0400X

License

01989 Issued in MO

Legal business name

SUN LAKES PHYSICAL THERAPY INC

Practice address

204 Seminary St
Warsaw, MO 65355

Phone

(660) 438-6993

Fax

(660) 438-6943

NPI assigned

Dec 14, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Robert Chapman

Title

President

Phone

(660) 438-6993

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Outpatient physical therapy / speech pathology certification: CCN 266598

Legal name

SUN LAKES PHYSICAL THERAPY

Certification status

Active

Provider type (POS)

Outpatient physical therapy / speech pathology

Participating since

Jul 29, 1996

Last certification

Jan 25, 2022

Ownership / control type

Proprietary

Facility address

204 Seminary St., PO Box 383
Warsaw, MO 65355

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1166054400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1271116800000",
    "number": "1255493334",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 383",
            "city": "WARSAW",
            "state": "MO",
            "postal_code": "653550383",
            "telephone_number": "660-438-6993",
            "fax_number": "660-438-6943"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "204 SEMINARY ST",
            "city": "WARSAW",
            "state": "MO",
            "postal_code": "65355",
            "telephone_number": "660-438-6993",
            "fax_number": "660-438-6943"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUN LAKES PHYSICAL THERAPY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-14",
        "last_updated": "2010-04-13",
        "status": "A",
        "authorized_official_last_name": "CHAPMAN",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "660-438-6993",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": "MO",
            "license": "01989",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "578490005",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Drew A Smith, M.D.
• Lauren Sons, LMSW
• Michael Sperry, PHARMD
• Peter Howard Steadman, DMD
• Rebecca L Steenburgen, LPC
• Subashini Sundram, OTR
• Kaleem Uddin Syed, MD
• Kelli Kathleen Tate, PHARMD
• Kaetlyn Leigh Taunton, PHARMD
• Jeffrey R Tedrow, M.D.

• Rehabilitation Clinic/Center in Warsaw, MO
• Providers in Warsaw, MO by specialty
• Rehabilitation Clinic/Center in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.